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Dr. Mark, Psychotherapist

Category: Mental Health

Satisfied Customers: 5200

Experience: Dr. Mark is a PhD in psychology in private practice

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I get aroused but cant achieve an erection. I wake up with

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I get aroused but can't achieve an erection. I wake up with an erection at times so I don't think it is physical in nature. I have tried a couple of supplements which appears to increase the desire, but still no results.

First, let me say I can imagine this is very frustrating for you. From your question it seems that nothing else is prominent as a problem either physiologically or psychologically. So, let's deal with this problem on its own.

That you can get an erection in your sleep is not evidence that there are no physiological reasons at play here. However, you are correct that most likely there is a psychological aspect to this; while it may not be the 100% cause, it is likely a big part of the problem.

Still, the first recommendation I should make is a PDE-5 inhibitor like Viagra or Cialis. A lot of men really like the Cialis daily pill because you don't have to plan an hour or more in advance. The point here is that as we age there can be some nerve damage and damage to small blood vessels that have accumulated. Erections are based on blood flowing to the penis and thus hardening it. Nerve weakness can cause that to no longer be activated as well. Thus, you might find that these medications are helpful to you. You would need to talk to your doctor to make sure you have no problems that would rule out these medications.

That said, the psychological problems are what you are sensing might be most prevalent here. If so, then we are referring to a type of performance anxiety. Again, given that as we age our ability to produce an "instant" erection diminishes, many men can begin to get phobic about this and this worry makes the erection problem grow into a mental block.

Okay. Mental block is a bit of a layman's term but that's the problem most often. So I'd like to make three suggestions to you with directions for you to follow. First is a technique called paradoxical intention. Second is hypnotherapy. And third is relaxing about it. You choose the order you want to apply them, okay?

One: They did a fascinating study on professional golfers and choking a few years ago. They wanted to know what caused choking, which is when the athlete is perfectly capable of winning but plays awfully in the big game. Why does this happen?

They found that the cause was not the athlete LOST concentration and focus. It was the opposite! The athlete was SO focused, was concentrating so hard, that he did not let his natural abilities come through and guide his body to do what he should do. Choking is actually caused by hyperfocus.

Performance anxiety in sex is a similar idea: so, I'm going to give you to try first a quick technique that the great psychiatrist Viktor Frankl came up with for this problem in his practice: it is called paradoxical intention.

But let's read what Frankl himself said: “A young physician consulted me because of his fear of perspiring. Whenever he expected an outbreak of perspiration, this anticipatory anxiety was enough to precipitate excessive sweating. In order to cut this circle formation I advised the patient, in the event that sweating should recur, to resolve deliberately to show people how much he could sweat. A week later he returned to report that whenever he met anyone who triggered his anticipatory anxiety, he said to himself, “I only sweated out a quart before, but now I’m going to pour at least ten quarts!” The result was that, after suffering from his phobia for four years, he was able, after a single session, to free himself permanently of it within one week.”

The way it works is: when you are going to have sex, that is, from when you first know that you are going to have sex, you tell yourself: "Okay[your name] , I dare you to be more nervous and shakier and limper and more flaccid than you have ever been before!!!! Go ahead penis, you are going to be that weakling you're so afraid of!!!"

Do you get the idea? It seems kind of silly, but you will be surprised how many people this simple psychological technique has helped!! The idea is that you have to challenge your performance anxiety. You have to be bold and dare it. You have to make fun of it and you have to trash talk to it. Serious!

Two: hypnotherapy. Please note I am talking about only hypnotherapy, which is a recognized form of psychotherapy used by psychologists and psychotherapists. So I'm not talking about people who put in ads in newspapers for hypnosis. Maybe those are useful or maybe not, I can't say. But a psychologist trained in hypnotherapy is a real licensed therapist. Even so, here's the important statement about hypnotherapy: hypnotherapy can help with a specific problem and that's why I'm thinking of it. HOWEVER, there are good and honest hypnotherapists and there are other types. Your only way of assessing is two ways: first, make sure he or she is a licensed psychologist. Don't let anyone tell you they are a licensed hypnotherapist. There is no licensure in most states that I know of. It's all a "self-licensing" which is not good enough. So you want to know his or her license number as a psychologist and call the state licensing board to make sure there have been no complaints filed. Please do not skip this step.

Three: Okay, this one is the one that most people try first because it's easiest and has a track record of good results. The key to this approach:

Do not make it SUCH a big deal out of it. This requires trusting your sexual partner. But most men find that women are very happy to use this approach and are not nearly so uptight or judgmental as the man himself. You have to accept, okay, you may not have an orgasm this time. This is not the end of the world. Why? Because the self-help I'm trying to teach you is that the key to sex you have to work on is: pleasure and not orgasm. I need you to instead of identifying how you can have an erection that then leads to an orgasm instead reorient your view to how can you and she have pleasure. She's having pleasure through orgasms, great. One day you will too. But that doesn't mean that you touching her, intercourse, and oral sex can't be pleasurable. And she touching you and stroking your back and your thighs, etc. can't be pleasurable.

So, the key: when it stops being pleasurable; when you're tired of it, that's when you've had enough. If it means just her coming and you can relax while she strokes your back, fine. Do you both see the picture? You're too focused on the erection and you need to get out of that box right now because you're not there. So let her touch your penis, your balls, whatever. For pleasure though, right?

Okay, I wish you the very best!

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Hello sir, I will review your advice but part of the problem is my wife no longer seems interested so I really don't have a sex partner right now so I revert to fantasy and porn to try and achieve the erection. The problem started when we had a bad session and she was very critical. I tried using the injections from Boston Medical group but that always meant having to schedule the sexual event.

Are you referring to Intracavernosal penile injections (IPE)? If so, you're right that it's a hassle, though it's rarely ineffective. In fact, though, that's why I mentioned Cialis daily pills: for this very reason. Because men really have a hard time with the advanced planning required for regular Viagra and Cialis. The daily pills are much easier, at least with the men that I've worked with in my private practice.

This issue with your wife is, you're right, the primary problem here. I'm concerned with your focusing on porn and masturbating only. The main concern is that it can lead to an inability to sexually perform with a partner. I know that sounds weird, but I've had to deal with this more than any other problem associated with inability to have sex with a partner: years of arousal only through porn.

So, getting your wife to want to try again is imperative. Two steps:

The first one is tough if she's embarrassed to talk with her gynecologist. But she needs to have testing done for hormone levels, including testosterone (yes, women also have this hormone) and the female hormones, Vitamin D levels, etc. Women also go through sexual changes and there's no need to avoid using the help that we now have available. Women can have good sexual lives for a long time these days and there's no reason not to. (You are welcome to show her my answer.)

The second part is for her to be willing to give sex another chance. This might need to happen with counseling. She can ask her gynecologist for a referral for the two of you or you two may want to seek an experienced sex therapist. By that I mean a psychologist or psychotherapist who is certified by either the AASECT (http://www.aasect.org/) or the American Board of Sexology (http://www.americanboardofsexology.com/). You would both want to go this therapy and work on the sexual problem in the marriage that needs to be addressed. This is not something to be ashamed of or hesitant about. The problem is too entrenched, meaning it's been going on too long in the marriage. And so a trained sex therapist may be the most effective way to address the problem so that the two of you can feel more intimate with each other and more emotionally closer as well as sexually fulfilled.

I wish you the very best!

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

I will tell you that...the things you have to go through to be an Expert are quite rigorous.

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